Semrau Maya, Gronholm Petra C, Eaton Julian, Maulik Pallab K, Ayele Bethel, Bakolis Ioannis, Mendon Gurucharan Bhaskar, Bhattarai Kalpana, Brohan Elaine, Cherian Anish V, Daniel Mercian, Girma Eshetu, Gurung Dristy, Hailemariam Ariam, Hanlon Charlotte, Healey Andy, Kallakuri Sudha, Li Jie, Loganathan Santosh, Ma Ning, Ma Yurong, Metsahel Amani, Ouali Uta, Yaziji Nahel, Zgueb Yosra, Zhang Wufang, Zhang Xiaotong, Thornicroft Graham, Votruba Nicole
Centre for Global Health Research, Brighton and Sussex Medical School, Brighton, UK.
Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
Int J Ment Health Syst. 2024 Nov 18;18(1):35. doi: 10.1186/s13033-024-00649-3.
Stigma and discrimination towards people with mental health conditions by their communities are common worldwide. This can result in a range of negative outcomes for affected persons, including poor access to health care. However, evidence is still patchy from low- and middle-income countries (LMICs) on affordable, community-based interventions to reduce mental health-related stigma and to improve access to mental health care.
This study aims to conduct a feasibility (proof-of-principle) pilot study that involves developing, implementing and evaluating a community-based, multi-component, awareness-raising intervention (titled Indigo-Local), designed to reduce stigma and discrimination and to increase referrals of people with mental health conditions for assessment and treatment. It is being piloted in seven sites in five LMICs-China, Ethiopia, India, Nepal and Tunisia-and includes several key components: a stakeholder group workshop; a stepped training programme (using a 'Training of Trainers' approach) of community health workers (or similar cadres of workers) and service users that includes repeated supervision and booster sessions; community engagement activities; and a media campaign. Social contact and service user involvement are instrumental to all components. The intervention is being evaluated through a mixed-methods pre-post study design that involves quantitative assessment of stigma outcomes measuring knowledge, attitudes and (discriminatory) behaviour; quantitative evaluation of mental health service utilization rates (optional, where feasible in sites); qualitative exploration of the potential effectiveness and impact of the Indigo-Local intervention; a process evaluation; implementation evaluation; and an evaluation of implementation costs.
The output of this study will be a contextually adapted, evidence-based intervention to reduce mental health-related stigma in local communities in five LMICs to achieve improved access to healthcare. We will have replicable models of how to involve people with lived experience as an integral part of the intervention and will produce knowledge of how intervention content and implementation strategies vary across settings. The intervention and its delivery will be refined to be feasible and ready for larger-scale implementation and evaluation. This study thereby has the potential to make an important contribution to the evidence base on what works to reduce mental health-related stigma and discrimination and improve access to health care.
在全球范围内，社区对有心理健康问题的人存在污名化和歧视现象很常见。这可能给受影响者带来一系列负面后果，包括难以获得医疗保健服务。然而，来自低收入和中等收入国家（LMICs）关于以社区为基础的、可负担得起的干预措施以减少与心理健康相关的污名化并改善心理健康护理服务可及性的证据仍然不完整。
本研究旨在开展一项可行性（原理验证）试点研究，包括开发、实施和评估一项以社区为基础的、多组成部分的提高认识干预措施（名为“靛蓝 - 本地”），旨在减少污名化和歧视，并增加将有心理健康问题的人转介进行评估和治疗的次数。该研究正在五个低收入和中等收入国家（中国、埃塞俄比亚、印度、尼泊尔和突尼斯）的七个地点进行试点，包括几个关键组成部分：利益相关者小组研讨会；针对社区卫生工作者（或类似工作人员 cadre）和服务使用者的阶梯式培训计划（采用“培训培训师”方法），包括反复监督和强化课程；社区参与活动；以及媒体宣传活动。社会接触和服务使用者的参与对所有组成部分都至关重要。该干预措施通过混合方法的前后研究设计进行评估，包括对污名化结果进行定量评估，测量知识、态度和（歧视性）行为；对心理健康服务利用率进行定量评估（在可行的地点为可选）；对“靛蓝 - 本地”干预措施的潜在有效性和影响进行定性探索；过程评估；实施评估；以及实施成本评估。
本研究的成果将是一种根据具体情况调整的、基于证据的干预措施，以减少五个低收入和中等收入国家当地社区与心理健康相关的污名化，从而改善医疗保健服务的可及性。我们将拥有可复制的模式，说明如何将有实际生活经验的人纳入干预措施的组成部分，并将了解干预内容和实施策略如何因环境而异。干预措施及其实施方式将得到完善，以使其可行并为大规模实施和评估做好准备。因此，本研究有可能为关于减少与心理健康相关的污名化和歧视以及改善医疗保健服务可及性的有效措施的证据基础做出重要贡献。
